By Amy Killelea and Justin Giovannelli
Over the past year, Secretary of Health and Human Services (HHS) Robert F. Kennedy Jr. fully replaced the members of the Advisory Committee on Immunization Practices (ACIP), with significant consequences for how the body reviews evidence and makes recommendations. In a break with past practice, ACIP has begun removing universal recommendations from some vaccines and, without new evidence, effectively downgrading them to a shared clinical-decision making (SCDM) designation. Unlike a universal recommendation, SCDM replaces the default recommendation to vaccinate with a murkier recommendation suggesting that a vaccination decision be made after a conversation between the patient and provider. While the Affordable Care Act (ACA) is clear that SCDM recommendations are covered without cost sharing, the nature of SCDM may create confusion among patients, providers, and payers. State and federal regulators can address this confusion by clarifying that coverage mandates include SCDM recommendations and ramping up insurer monitoring and oversight activities. In a recent article for The Commonwealth Fund’s To The Point blog, CHIR faculty discuss new federal vaccine recommendations and how ambiguity could prove challenging for consumers.